Have you ever been delinquent in paying rent during the last 3 years?
_____

Name of Last Landlord:

__________________

Tel. Number:

_______________

CONSENT TO OBTAIN CREDIT INFORMATION

As a material inducement to be considered as a tenant for the Premises, I herewith
consent to and authorize _______________________, or any agent of same, to contact all
references named in this application, and to
conduct a credit review, including obtaining my credit report from any authorized
credit reporting agency.

I declare under penalty of perjury that the information listed in this
application is true and correct.

Executed on this _____ day of _______________, , in the
city of _______________, state of _______________.